Organization
COMMONWEALTH VEIN CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK L FOREST D.O. (CO OWNER)
(804) 754-6707
Entity
Organization
Contact information
Practice address
518 W ATLANTIC ST, SUITE A, SOUTH HILL, VA 23970-1906
(804) 754-6707
Mailing address
518 W ATLANTIC ST, SUITE A, SOUTH HILL, VA 23970-1906
(804) 754-6707
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
12/12/2014
Last updated
12/12/2014
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